Text 4 Health

woman textingText messaging provides an opportunity to improve health knowledge, behaviors, and clinical outcomes, particularly among hard to reach populations.

With the recent proliferation of health text messaging applications in the United States, emphasis should be placed on addressing gaps in knowledge about the effectiveness and acceptance of health text messaging programs. Future efforts should include

  1. conducting an ongoing environmental scan of the field, 
  2. performing systematic reviews of new research and sharing lessons learned, and 
  3. determining the reach of text messaging programs, particularly among underserved populations. 

The trends toward wide spread ownership of cell phones and widespread text message use across virtually all segments of the U.S. population will continue to support the spread of health text messaging programs. This scan provides encouraging evidence related to the use of health text messaging to improve health promotion, disease prevention, and disease management.

HRSA supports two text messaging programs, TXT4Tots and Text4baby.


womand and babyTXT4Tots is a library of short, evidence-based messages focused on nutrition and physical activity. The library is targeted to parents and caregivers of children, ages 1-5 years, and is available in English and Spanish. Content for the messages was derived from American Academy of Pediatrics (AAP) Bright Futures: Guidelines for Health Supervision of Infants, Children and Adolescents, which uses a development-based approach to address children’s health needs in the context of family and community.

The TXT4Tots library of messages were developed under a cooperative agreement between HRSA and the American Academy of Pediatrics (AAP) under Grant Award U04MC07853. HRSA  reserves a royalty-free, non-exclusive and irrevocable right to reproduce, publish, or otherwise use the Libraries for Federal purposes, and to authorize others to do so. Before you download, see our End User Agreement and Frequently Asked Questions.

The library works for cell phone text messaging and much more. For ideas, see 


pregnant woman on cell

Text4baby is a free mobile health education service that provides pregnant women and new moms with an infant less than one year of age with free, evidence-based,  brief health messages. Dads, grandparents, and other caregivers can sign up as well.

The free text messages provide tips on subjects including breastfeeding, car seat safety, developmental milestones, emotional well being, exercise and fitness, immunizations, labor and delivery, nutrition, prenatal care, safe sleep, and stop smoking. The text messages also provide 1-800 numbers and other resources to learn more.

Text4baby is an education campaign of ZERO TO THREE. HRSA is one of more than 1000 partners encouraging women to take advantage of this free service.

  • Text4baby to sign up for the service, become a partner and learn more.


National Evaluation

NEW - Promoting Maternal and Child Health Through Health Text Messaging: An Evaluation of the Text4baby Program Report (PDF - 1.94 MB)  Report and accompanying Summary of Key Findings (PDF- 968 KB). This collaborative effort is the culmination of a multi-year quantitative and qualitative inquiry to better understand the national roll out of the Text4baby program as well as experiences in diverse communities.

Using Health Text Messages to Improve Consumer Health Knowledge, Behaviors, and Outcomes: An Environmental Scan (PDF - 843 KB) is a component of the evaluation. The report examines studies on the effectiveness and acceptance of health text messaging interventions published between January 2009 and October 2012, including seven systematic reviews and a synthesis of evidence from the Agency for Healthcare Research and Quality Health Care Innovations Exchange. The scan focuses on individual-level interventions in the United States and other high-resource countries.